InHIP CVD Remote Monitoring

In total it’s estimated that more than 900,000 people in the UK have heart failure with around 200,000 new diagnoses every year. [1] HF puts significant pressure on the NHS, accounting for 1 million bed days per year, 2% of the NHS total budget and 5% of all emergency hospital admissions.[2] More than 60,000 people die of HF each year, and inpatient mortality for patients admitted to hospital with HF in England and Wales is 9.2%. This increases to 39% within 12 months of those who survive to discharge. Overall, 50% of people with HF are either readmitted to hospital or die within a year of admission to hospital.[3]

Early diagnosis, comorbidity management, optimal secondary prevention, cardiac rehabilitation (CR) and patient enablement are key to reducing readmission rates for patients living HF. The NHS Long Term Plan (LTP) commitments include:​ people with HF and heart valve disease being better supported by multi-disciplinary teams as part of PCNs ​improved access to and uptake of CR to save lives, improve quality of life and reduce hospital readmissions. The LTP sets a target of 33% of eligible people with HF being offered CR by 2028 the ambition to roll out personalised care to 2.5 million people by March 2024.

The Local Picture

Heart & circulatory diseases kill 3 in 10 people in North Devon, and around 1,100 people have been diagnosed with heart failure by their GP. North Devon has a population of 98,170 with areas of high deprivation, including areas in Barnstaple and Ilfracombe within the top 10% and 20% most deprived in the country. North Devon District Hospital based in Barnstaple, provides a heart failure service for the whole of North Devon, a large coastal and rural constituency, featuring a higher-than-average age distribution. The rural geography, with associated inequalities in access to cardiovascular care (including the monitoring required to safely introduce new medications) presents challenges in providing care and improving outcomes. There are also challenges relating to digital exclusion resulting in inequity of access to services.

Vulnerable and ‘at risk’ groups (including people with comorbidities, severe mental illness and learning disabilities) with HF in North Devon experience barriers to accessing the HF service. We need to understand and address these access barriers.

North Devon District Hospital currently uses non-digital remote monitoring, but the service is limited in scope and not equitable (not available to HFpEF patients and relies on people to be able to afford their own kit at home). Heart failure preserved ejection fraction (HFpEF) patients are known to have high levels of readmission and long inpatient stays (with more comorbidities). Many patients live with a burden of symptoms, and require titration of disease modifying medications.

Close monitoring is required to safely introduce new medication for the cohort and there is a significant gap for outpatients, or people recently discharged home, where some additional information about observations, symptoms and weight, might feed into decision making and improve timeliness of treatment optimisation, enhancing patient outcomes.

Health Inequalities

Health inequalities (deprivation) general

Socio-economically deprived groups have also been shown to have consistently worse outcomes than the most affluent groups. They face a 20% higher risk of all-cause hospitalisation, even after adjustment for other factors. This inequality has persisted for over 20 years.

Health inequalities (Severe Mental Illness) general

People with Severe Mental Illness (SMI) often develop chronic physical health conditions at a younger age than people without SMI, including coronary heart disease (CHD), stroke and heart failure increasing the risk of premature death.

Health inequalities heart failure specific

Though heart failure affects nearly one million people across the UK, diagnosed prevalence varies significantly across different regions. Contrary to popular belief, heart failure is not just a disease of the very old, and many people live with heart failure from an earlier age. While the average age of a UK heart failure patient is 75, this drops to 69 for people from black and minority ethnic backgrounds. The average is in the low 60s for some cohorts, including the most socio-economically deprived. Premature death rates from CVD in the most deprived 10% of the population are almost twice as high in the least deprived 10%.

[1] BHF. 2023. UK factsheet. BHF UK CVD Factsheet

[2] NICE 2018. Resource impact report: Chronic heart failure in adults: diagnosis and management (NG106).

[3] NICOR. 2022. National Heart Failure Audit. NHFA-DOC-2022-FINAL.pdf (nicor.org.uk)

[4] BHF. 2022. Local Statistics | British Heart Foundation (bhf.org.uk)

[5] Devon County Council. 2020. Mid-year population estimates by age and gender – Facts and Figures (devon.gov.uk)

[6] Indices of Deprivation 2015 and 2019 (communities.gov.uk)